Module 21: Weekly Program Census Form

A Module Used in The Measurement Group's Cross-Cutting Evaluation of the HRSA HIV/AIDS Bureau's Special Projects of National Significance on Innovative Models of HIV/AIDS Care

Purpose

• Method for capturing the weekly census on functional service units.

Content Domain - Weekly total census, demographic characteristics of census, method of collecting census.

Operational Data Items - Site, Sub-Provider, Week of, Staff Code, Total Number of Patients/ Clients This Week, Number of HIV+ Patients in Each Service Category (Males and Females separately).

Citation - Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1996). Module 21: Weekly Program Consensus Form. Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.

Usage - Permission is granted for non-commercial use so long as form is not altered, the copyright is not removed, and a proper citation is made to the instrument. Non-commercial use is use by a not-for-profit organization in which the instrument is not sold. If you have questions about appropriate and proper uses, contact The Measurement Group.